Biological influence of

restorative materials

By
Dr: Reham sayed
I. Introduction.
II. Theories of pain Transmission.
III. Factors influencing the pulp response to
restorative materials.
IV. Influence of restorative procedures on dento
pulpal organ.
V. Influence of restorative materials on dento-pulp
complex.
VI. Iatrogenic Error.
I. Introduction.
II. Theories of pain Transmission:

a. Enervation theory.
b. Transduction theory.
C. Hydrodynamic theory.
 a. Enervation theory (neural).

It explains that the injured nerve can generate

impulse and elicits pain.

Accepted discarded.
 b. Transduction theory.
It explain that different stimulus can
Injure the odontoblast which in turn
Produce impulse that received by the
Nerve endings → pain.

Accepted Discarded.
 C. Hydrodynamic theory.

It explain that outward and inward

movement of dentinal fluid can
cause direct deformation of the
free nerve ending → pain.

Accepted Discarded.
 III. Factors influencing the pulp response to restorative
materials.
1. Degree of irritation & reparative power of the pulp.
 Degree of irritant:
Mild- moderate irritation →vital odontoblast (scelorotic-calcific barrier).
↑ reparative power (no clinical symptom).
Severe irritation →degenerated odontoblast (dead tract)↓reparative power

• State of the pulp:

young normal healthy pulp → ↑ reparative power.
↑ Reparative power → ↓inflammation (no clinical symptom).
↓ Reparative power → ↑inflammation (necrosis).
2. Condition of pulp floor:
*multiple small non hemorrhagic exposures (bacterial invasion).
*Degree of flexibility & RDT.
3.The remaining dentin thickness:
*Effective cavity depth: Distance along D.T (accurate).
*Clinical cavity depth : Dentin Bridge.
*Actual cavity depth : Enamel +Dentin.
 ↓Effective cavity depth → ↑ multiple microscopic exposures.
↑ D permeability, ↓ thermal insulation.
4. Irritational quality of restorative material:

Screening test → evaluate toxic reaction.

First screening test: subcutaneous pellet (rat and dogs).
Second screening test: cultured pellet (clearance zone).
Usage test → -evaluate the irritational effect of restorative
material on pulp.
-Class V cavities are prepared in experimental animals, after
different intervals → extracted, decalcified to be examined.
-more valid as it measure pulpal reaction.
5.Sealing ability of restorative material:

• Amalgam and direct gold filling → surpass other materials!

• Composite → nowadays is satisfying.

• Glass Ionomer → excellent initial sealing ability.

• Indirect restoration →lack adaptation but now (resin

cement).
 IV. Influence of restorative procedures on dento-
pulpal organ.
1. Trauma:
Guidelines:
- Sharp hard cutting inst.
- Sharp rotary cutting with coolant
- In deep cavities →avoid ↑ speed & ↑pressure to prevent odonoblastic
trauma (aspiration)
- Cutting of fresh dentin → expose more dentinal tubules →bacteria↓
pulpal irritation
Drawbacks of excessive trauma:
-Histological changes of the pulp (hyperemia).
-Aspiration of odontoblastic nuclei into dentinal tubules by
capillary action.

So we must avoid
• Cutting across recessional lines.
• Over cutting of Enamel.
• Over cutting or Deeping in dentin.
• Excessive pressure.
 2.Thermogenesis:

Due to: - Friction bet cutting tool & tooth structure.

- ↑ pressure - ↑ speed
- Type of tissue to be cut.
- Size & material of bur.
Otherwise pulpal reaction will occur:
Aspiration of odontoblastic nuclei
Irreversible pulpits.
depends on - Depth of cavity (approximating of pulp)
- State of the pulp.
- Operative procedure.
3-Speed:
• Any speed without coolant → variable pulp change.

• However high speed with coolant → least pulp response.

• Low speed with coolant → more traumatic when compare

with high speed with coolant at the same depth due to more
force applied to induce cutting → heat.
4-Pressure:
Reverse relation - ↑ speed →↓ pressure
Otherwise → pressure cause:
-Aspiration especially at ↓ cavity depth.
-Bacteria → pulp infl.
5-Vibration:
Due to eccentricity of rotary instrument cause:
•Patient discomfort.
•Enamel cracks.
•Improper & uncontrolled cutting.
•May cause different degree of pulp damage.
Otherwise:
• Rebound response: (limited area of necrosis)

• Calcio-trumatic response: (bands of hyper or hypo

calcification → indicate sever reduction in Dentin formation &
abnormal ratio between fibrils & cementing sub.

• Edema, fibrosis of pulp, other changes of the pulp (↓

predentin).
6-Desiccation:
Desiccation or overdryness of dentin is due to:

• Over heating.

• Use chemicals.

• Excessive use of air coolant.

So we have to use air-water spray to avoid desiccation & heat

generation.
7-Pin drilling & insertion:
-Dull drill→ pressure (pulpal inflamation)
-Improper direction.
-Oversized.
-Thermal & galvanic irritation.
8-Cavity depth:
-↓effective cavity depth →↑ permeability →
↑ pulp injury

-So the presence of 2 mm dentin thickness

protect the pulp.
9-Chemico-mechanical caries removal:

carisolv → chemical irritation to the pulp.

10-Laser.
• Laser → produce heat (nowadays biolse)
• Low power laser: used in pulp capping ( ablation).
• High power laser: used in cavity preparation and etching.